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ECG and echocardiographic diagnosis of pulmonary thromboembolism associated with central venous lines
A J Pollard1, N Sreeram, J G Wright
1Children's Hospital, Ladywood Middleway, Birmingham.
Insights
Pulmonary embolism (PE) is common in children with long-term central venous lines. Echocardiograms and electrocardiograms (ECGs) can help diagnose PE, which may impact survival and transplant eligibility.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care
- Pediatric Radiology
Background:
- Central venous lines (CVLs) are essential for long-term management in critically ill children.
- Complications associated with CVLs, such as venous thromboembolism, require careful monitoring.
- Pulmonary embolism (PE) is a potentially life-threatening condition that may be underdiagnosed in pediatric populations.
Purpose of the Study:
- To determine the prevalence of pulmonary embolism in children with central venous lines in place for over three months.
- To evaluate the utility of electrocardiograms (ECGs) and echocardiograms in diagnosing PE in this pediatric cohort.
- To assess the impact of PE on patient outcomes, including mortality and transplant candidacy.
Main Methods:
- Retrospective analysis of 21 children with central venous lines in situ for > 3 months.
- Evaluation of 12-lead electrocardiograms (ECGs) and echocardiograms using established criteria for PE.
- Comparison of ECG findings with standard pediatric ECG values and echocardiographic measurements with age-matched norms.
Main Results:
- Pulmonary embolism was diagnosed as definite in 7 patients, probable in 5, and absent in 9.
- Abnormal ECG findings suggestive of PE were observed in 57% of patients.
- Echocardiography revealed right ventricular dilation in 88% of patients with abnormal ECGs.
- Postmortem evidence of pulmonary thromboembolism was confirmed in two cases.
Conclusions:
- Pulmonary embolism is a frequent complication in children with long-term central venous lines.
- Serial ECG monitoring and echocardiography are valuable tools for diagnosing PE in this population.
- Undiagnosed PE may adversely affect long-term survival and preclude eligibility for organ transplantation in children with complex medical conditions.
Abstract:
The aim was to establish the prevalence of pulmonary embolism in 21 children (median age 12 months; range 5-132 months) with central venous lines in situ > 3 months (median 10 months; range 3-47). Twelve-lead electrocardiograms (ECGs) and echocardiograms were analysed in a retrospective study using ECG and echocardiographic criteria for pulmonary embolism-previously established and validated in adult patients- and standard paediatric ECG values as control data. Patients were scored as having definite (n = 7), probable (n = 5), or no pulmonary embolism (n = 9). Overall 57% of ECGs showed abnormalities compatible with pulmonary embolism. In two patients, serial ECGs obtained during an acute cardiorespiratory illness showed cumulative changes diagnostic of pulmonary embolism. Eight of 12 patients with abnormal ECGs had echocardiography; in seven of these (88%) the right ventricular end diastolic diameter was > 2SD above the mean value for age. Twelve of the patients included in this study have died; two died following an acute respiratory illness. There was postmortem evidence of pulmonary thromboembolism in both of the two children for whom necropsy information was available. The data suggest that pulmonary embolism is common in children who have central venous lines in situ for > 3 months. Serial studies are of value in some patients. Pulmonary embolism may compromise the long term survival of children with small bowel failure and preclude consideration for liver and small bowel transplantation.